HOSPICE

a home or hospital established to relieve the physical and emotional suffering of the dying. The term hospice dates back to the European Middle Ages, when it denoted places of charitable refuge offering rest and refreshment to pilgrims and travelers. Such homes were often provided by monastic orders; the most famous of them, the hospice of St. Bernard, still functions as a shelter for travelers passing over the Pennine Alps. Although special hospitals for the terminally ill had existed prior to the 20th century, it was not until after World War II that recognition of the special needs of the dying led to the modern hospice movement. Cicely Saunders, one of the initiators of the movement and the founder of St. Christopher's Hospice, London (1967), and other health professionals recognized that many established procedures of modern medical care could be inappropriate when applied to those who are dying. The aggressive life-prolonging measures routinely taken in intensive-care units often only increased the discomfort and isolation of terminally ill patients and deprived them of the opportunity to die in a peaceful and dignified fashion. In response to the absence in the medical system of provisions for the supportive care of this class of patients, the modern hospice was developed. The hospice functions as a sympathetic and reassuring environment dedicated to making the last days of the dying as pleasant as possible. The prevention of physical pain is the first priority, and analgesics, tranquilizers, and physical therapy are used to alleviate physical suffering. Hospices emphasize the prevention, rather than the mere control, of pain through vigilant monitoring and by the tailoring of drugs and their dosages to patients' individual needs. Patients in hospices receive moral support from loved ones as well as the staff itself, and a variety of measures are used to further their emotional and spiritual well-being. Patients are usually admitted to a hospice on referral by a physician after a prognosis for survival of only months or weeks. Care may be provided completely within a health facility, on an outpatient basis, or at home.